Provider Demographics
NPI:1699830026
Name:KIM MORE PHARMACY CORPORATION
Entity Type:Organization
Organization Name:KIM MORE PHARMACY CORPORATION
Other - Org Name:KIM LONG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-777-1414
Mailing Address - Street 1:PO BOX 720712
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77272-0712
Mailing Address - Country:US
Mailing Address - Phone:713-777-1414
Mailing Address - Fax:713-777-1417
Practice Address - Street 1:7601 W SAM HOUSTON PKWY S
Practice Address - Street 2:STE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5227
Practice Address - Country:US
Practice Address - Phone:713-777-1414
Practice Address - Fax:713-777-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX253283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2099902OtherPK